1102 A Rare Case of Parenchymal Liver Injury Presenting Initially as an Obstructive Jaundice

Abstract

Abstract Parenchymal liver damage is secondary to a sudden insult on hepatocytes, most commonly due to hepatitis or secondary to drug injury. A 43-year-old gentleman with a pre-existing diagnosis of fatty liver disease, presented with obstructive jaundice. He had a bilirubin of 159 and ultrasound imaging showed gallstones in his gallbladder with a dilated common bile duct (CBD) of 6.7mm. An MRCP showed a dilated CBD with an intraluminal filling defect. He was discharged home when clinically well and referred for an outpatient ERCP. This did not happen for three weeks and at this point, no cause of obstruction was identified, but a plastic biliary stent was inserted. Despite this, his liver function worsened, and he was readmitted with a bilirubin of 421. Following discussion within a multidisciplinary team he underwent a further CT scan and ERCP with stent replacement, these showed no evidence of obstruction. All acute hepatic and virology screens were negative. His bilirubin continued to uptrend hitting 644 and he became coagulopathic with an elevated INR of 2.7. The patient admitted to taking weight loss supplements including a “fat burner” powder regularly for the last two months, in keeping with the duration of his worsening liver dysfunction. He underwent a liver biopsy; the results of which are pending and is currently being treated supportively. This case presented an interesting diagnostic challenge and there remains ongoing uncertainty. The current working diagnosis is that of an obstructive jaundice which has exacerbated an underlying parenchymal liver injury secondary to supplement use.